Our Businesses, Our Selves

One hot summer afternoon John, a psychotherapist in private practice for 17 years, came into my office looking frustrated, complaining that his practice was going nowhere. Not that he didn't like doing therapy--he still loved it--but he felt stuck and frustrated in the practice itself. His income had barely inched upward over the past few years, he wasn't getting his name and practice out in the world as he wanted, and he felt increasingly overwhelmed by paperwork, as if the business part of his practice were running him, not the other way around. When I asked him to explain what he meant, he sighed and described the chaos of his office: journals, newsletters, papers, insurance forms, notes, bills, and whatnot were stacked on the desk, the table, the chairs, the floor, to such an extent that it was difficult to get around. "I know I'm really good at what I do, and I have dreams of expanding my practice and developing more of a reputation in my field," he said despondently, "but I can't seem to get organized to do anything about it. I thought I'd feel more settled and directed by this age, but I don't."

John's experience wasn't at all unusual. Psychotherapists don't go into clinical practice because they're such great businesspeople. They want to be helpers and healers, not entrepreneurs. Although most of them recognize the advantages, in terms of autonomy and income, that working within a private practice brings, the business world and terms associated with it--such…